I decided to begin my mental disorder awareness series with a disorder I am personally familiar with. In all likelihood, many of you will be familiar with it too, whether through personal experience or someone you know, even whether you were aware of it or not. Anxiety disorders are very common, so it’s important you educate yourself about what having an anxiety disorder means, for your own sake, your loved ones, and the sake of others in your community.
To start, I’m going to clear up a commonly confused interpretation of anxiety. Anxiety is the feeling of anticipation and worry over a future threat, as is perceived by the individual. Everybody experiences this. Feeling anxiety is not exclusive to individuals who have anxiety disorders. During an extremely stressful time, you may experience very intense anxiety, which is normal, and real, and should be attended to. For people with anxiety disorders, however, anxiety plays a more impactful role in their lives. What makes an anxiety disorder a disorder is, surprise surprise, disordered anxiety – anxiety which is excessive, persistent, and having a negative impact on an individuals life or functioning. It most often is brought on by an interaction between genetics and life events, experiences, or learning.
Some don’t understand how anxiety works, which leads to misunderstanding. It’s not as simple as just calming down, or taking some deep breaths, or telling yourself that what’s causing the anxiety isn’t worth feeling anxious about.
The Brain and Anxiety:
Inappropriate Threat Perception:
The fight-or-flight response exists to prepare you to face a threat. A threat is something that could cause you harm. Something that is dangerous. This response prepares you to either fight off an attack to defend yourself or to escape to save yourself. In people with anxiety disorders, this response is activated for things that are not actually a threat. For example in social anxiety disorder, one may be anxious and afraid of calling the doctors to the point that their fight-or-flight response is activated. This shouldn’t happen because calling the doctors doesn’t pose any risk or danger – calling the doctor can’t injure or kill you.
Brain Activity in Anxiety:
In the brain, when we perceive something we think is a threat to us, our amygdala (the center of our brain which controls our emotions and survival instincts) gets notified to send us into this ‘fight-or-flight’ mode. In people without anxiety disorders, this should be shut down if what was deemed threatening is realised to not actually pose you any risk, this is processed by your prefrontal cortex (your major logic and thinking region). Your prefrontal cortex then can communicate with your amygdala and stop the anxious response.
In the brains of people who have anxiety, however, scans show that there is lower than normal activity in the prefrontal cortex, and elevated activity in the amygdala. This means that the prefrontal cortex isn’t recognising that the perceived ‘threat’ isn’t a real threat, so it’s not communicating with the amygdala to get it to shut down the fight-or-flight response. This leaves the amygdala to be over-activated, maintaining the feeling of anxiety even if it is a disproportionate reaction.
Chemical Role in Anxiety:
A chemical in our brain called Gamma-Aminobutyric Acid (GABA) also plays a role in regulating our anxiety. When GABA binds to its specialised structures in the brain it lowers brain activity by reducing the electrical impulses. When we experience anxiety, GABA gets released as part of a cycle to prevent prolonged anxiety by reducing electrical activity in the amygdala, allowing, essentially, for you to relax. In people with anxiety disorders, there is overexposure to the stress hormone cortisol due to prolonged and excessive stimulation of the fight-or-flight response. This exposure to cortisol eventually results in a break down of these specialised structures in the hippocampus (a brain area involved in memory and emotion, part of the anxiety regulatory system) that GABA binds to. These structures are required for GABA to carry out its function. Fewer of these structures means less GABA can take effect. This means when you have an anxiety disorder, activation of the fight-or-flight response doesn’t get turned off as quickly as in someone without an anxiety disorder, and their anxiety isn’t as regulated, because this chemical in the brain has less opportunity to take effect.
There exists a variety of treatment options available for those who suffer anxiety.
- Different prescription drugs exist that can improve chemical functioning. They can relieve excess exposure to cortisol, allowing broken down structures in your brain to rebuild so that GABA can work properly. Some increase the functioning of other beneficial chemicals that improve anxiety symptoms such as serotonin. Doctors work with you to ensure they work well for you individually and are appropriate. The use of medication is better paired with therapy to treat the root cause as well.
- Cognitive Behavioural Therapy can help you change the way you think, so you no longer perceive inappropriate things as threatening.
- Therapy can also equip you with the tools you need to cope with bouts of anxiety so that it doesn’t have as much impact.
Symptoms and Different Anxiety Disorders:
While I can’t cover all anxiety disorders in this article, keep in mind that anxiety disorders share anxiety as a symptom, and ‘anxitey’ presents its own umbrella of symptoms that are common among the different types. The main differentiation between anxiety disorders is the stimulus that triggers anxious symptoms. For all disorders, for clinical diagnostic criteria to be met, symptoms must cause the individual significant distress and impair functioning or impact their life. If you or someone you know is being affected by anxiety, it’s worth taking some action to get on top of it, treatment really does help.
Different disorders have different criteria, their own extra symptoms, and their own different and specific triggers of the anxiety which differentiate them. Here are some of the more common anxiety disorders:
Generalised Anxiety Disorder:
As is suggested by the name, Generalised Anxiety relates to anxiety which doesn’t have a specific trigger, and can arise from little or no provocation. According to the current diagnostic criteria, Generalised Anxiety involves excessive anxiety and worry that is difficult to control and lasts most days for six or more months.
The anxiety and worry lead to three or more of the symptoms below:
- Easily tired
- Concentration issues, experiencing ‘mind blanks’
- Muscle tension
- Trouble with sleep
Panic attacks and Anxiety:
Panic attacks are a very real and terrifying experience for some who suffer anxiety disorders. Symptoms of anxiety and panic attacks may be similar, however, during a panic attack, the symptoms are significantly more intense. These symptoms may include:
- Overwhelming fear
- Racing heart
- Rapid breathing
- Chest pain
- Feeling of choking
- Fear of death
- Numbness or tingling
- Feeling disconnected from yourself and/or your surroundings
- Chills or hot flashes
Anxiety may build up gradually to exhibit some of these symptoms as a response to a stressor. Panic attacks often occur without provocation or warning, although they can also occur as a response to a stressor as well. Because of the severity of these symptoms during a panic attack, unlike anxiety, the experience may feel like a medical emergency, resulting in the fear of death or of losing control.
Phobic disorders are anxiety disorders where there is a specific thing, whether it be an object or situation, that the person responds to as a threat, even though it doesn’t pose any danger. In phobias, people go out of their way to avoid encountering their fear. If they are exposed to their fear, they feel extreme discomfort and anxiety which may result in a panic attack.
Examples of phobias include agoraphobia and social anxiety/social phobia, and some common and more well-known triggers such as snakes, spiders, blood, and needles.
Agoraphobia is often thought to be a fear of leaving the home or being outside, and while this can be a part of agoraphobia, that’s not what the disorder exactly is. Agoraphobia is an anxiety disorder which involves extreme anxiety or fear about more than one of the following situations in which they may not be able to escape or get help if they begin to panic:
- Public transport
- Open space
- Enclosed space (e.g. aeroplanes)
- Being in a queue or a crowd
- Being alone out of the house
This is an anxiety disorder I personally struggle with and is also very common. People with social anxiety disorder fear that they will behave in a way, or show anxiety symptoms (for example, blushing or sweating) that will cause embarrassment or humiliation.
Some activities which may be affected by social anxiety include things such as eating in front of others, asking for help in a shop, answering or making phone calls, public speaking or performing, meeting or talking to new people, or even being observed doing some kind of motor skill such as writing, running, or playing a sport. In some cases, it can cause extreme self-awareness resulting in the inability to perform behaviors naturally, which causes more anxiety.
Obsessive Compulsive Disorder (OCD):
People often joke about OCD, but the reality is that the disorder severely impacts the lives of those who have it. The obsessions or compulsions that an individual has are time-consuming and interfere with their day-to-day functioning or cause them distress or harm.
Obsessions in OCD are intrusive thoughts or impulses that are unwanted and may be disturbing, out of character, against their wants or needs, and that the individual may or may not know are irrational or extreme. The intrusive thoughts may cause the person a lot of distress as, even if they know it is extreme, depending on the nature of their obsession, they can truly be fearful for the wellbeing of others, even that they may cause harm to their loved ones.
The anxiety caused by these thoughts can result in behaviors adopted in order to cope. These behaviors are called compulsions. The behaviors may be used to prevent anxiety or distress, reduce it, or prevent something terrible they believe may happen from occurring. They’re defined as repetitive physical or mental behaviors. The behavior may be not connected in any logical way, or they may be obviously excessive.
Anxiety disorders are more complex than they appear, and can really impact peoples lives. Encourage people who are suffering to get help, or seek help yourself if any of this sets off alarm bells for you. Anxiety doesn’t define who you are as a person, it isn’t an expression of who you are, but an expression of an affliction you have to deal with.
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7. Social Anxiety Institute. DSM-5 Definition of Social Anxiety Disorder. https://socialanxietyinstitute.org/dsm-definition-social-anxiety-disorder
8. Beyond OCD.org. Clinical Definition of OCD. http://beyondocd.org/information-for-individuals/clinical-definition-of-ocd